Individual
DR. DOUGLAS JED PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
650 N STATE ST, SUITE #1, SHELLEY, ID 83274-5167
(208) 357-2225
(208) 357-2224
Mailing address
650 N STATE ST, SUITE #1, SHELLEY, ID 83274-5167
(208) 357-2225
(208) 357-2224
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-855
ID
Other
Enumeration date
03/15/2007
Last updated
07/09/2007
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